MEDICARE: MACKENZIE CLAIRE TRIPPEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1588504583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE CLAIRE TRIPPEL

Provider Business Mailing Address
First Line	:	801 NW 10TH ST APT 144
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6906
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 NW 10TH ST APT 144
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6906
Country	:	US
Telephone Number	:	913-258-3529
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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Directions to “ MACKENZIE CLAIRE TRIPPEL ” Practice Location

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